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About Us
Shades
Closets
Contact Us
About Us
Shades
Closets
Contact Us
Become a Dealer
Become a Dealer
Dealer Application Form
Full Name
Trade Name (if different)
Business Address
Address Line 2
City
State
Zip / Postal Code
Business Type
LLC
Corp
Partnership
Other
Business Type
State Business Formed
Date Business Formed
Federal EIN
State Resale Certificate
Main Contact
Office #
Cell #
Email
Have you done business under any other name in the past 5 years?
Yes
No
Have you or any company with which you were associated in the past 5 years been subject to any bankruptcy or insolvency proceeding?
Yes
No
Are there any judgments or legal proceedings pending or threatened respecting Buyer or any Guarantor?
Yes
No
Company Principals-Owners
Name
Title
DL
Home Address
Cell/Home#
Name
Title
DL
Home Address
Cell/Home#
Trade References
Name
Account #
Contact Name
Phone#
Email
Email
Name
Account #
Contact Name
Phone#
BUYER AGREES TO ALL OF THE TERMS AND CONDITIONS OF THIS DOCUMENT INCLUDING THOSE THAT FOLLOW THIS SIGNATURE ON THE NEXT PAGE
Dated
Buyer E-Signature
Title
Resale Certificate
Submit
